Hypertension and orthostatic hypotension with venlafaxine treatment in depressed older adults

Rafae Wathra, Benoit H. Mulsant, Lauren Thomson, Kyle W. Goldberger, Eric J. Lenze, Jordan F. Karp, Marcos Sanches, Charles F. Reynolds, Daniel M. Blumberger

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Venlafaxine, a serotonin–norepinephrine reuptake inhibitor, is often used as first- or second-line therapy for depression in older adults. It can be associated with adverse blood pressure (BP) effects. Methods: Adults ⩾60 years of age in a current major depressive episode were treated in a protocolized manner with venlafaxine XR; 429 participants were treated for 8–16 weeks with a daily dose up to 300 mg to achieve remission from depression. Cardiac measures included sitting and standing BP and heart rate. Results: Of participants who were normotensive at baseline, 6.5% were found to have elevated BP during the study (1.9% '225 mg/day; 9.8% ⩾225 mg/day). There was no significant change in mean BP in the overall sample, or in the subgroup treated with doses ⩾225 mg/day. Additionally, 20.1% of the participants who did not have orthostatic hypotension at baseline were found to have orthostatic hypotension (16.8% '225 mg/day; 22.4% ⩾225 mg/day). Participants with new-onset orthostatic hypotension were significantly more likely to fall than the other participants. Conclusion: A large proportion of older adults treated with venlafaxine experience orthostatic hypotension, putting them at risk for falls. A smaller proportion experience elevated BP. Older patients prescribed venlafaxine, particularly at high doses, should be advised and counseled about these adverse effects.

Original languageEnglish (US)
Pages (from-to)1112-1118
Number of pages7
JournalJournal of Psychopharmacology
Issue number10
StatePublished - Oct 1 2020
Externally publishedYes


  • Depression
  • geriatric
  • hypertension
  • norepinephrine
  • orthostatic hypotension
  • reuptake inhibitor
  • serotonin
  • venlafaxine

ASJC Scopus subject areas

  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)


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